1083096150 NPI number — DOROTHY ANNE EUGENIO GARCIA RDH, BSDH

Table of content: DOROTHY ANNE EUGENIO GARCIA RDH, BSDH (NPI 1083096150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083096150 NPI number — DOROTHY ANNE EUGENIO GARCIA RDH, BSDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
DOROTHY ANNE
Provider Middle Name:
EUGENIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH, BSDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083096150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2426 70TH AVE W
Provider Second Line Business Mailing Address:
APT. 215
Provider Business Mailing Address City Name:
UNIVERSITY PLACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-362-6638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2426 70TH AVE W
Provider Second Line Business Practice Location Address:
APT. 215
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-362-6638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  28675 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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